Testing patient targeted therapies in patients with temporomandibular joint disorder with the arthrokinetic reflex: individual patient research

Abstract

Traditional research in the health sciences has involved control and experimental groups of patients, and descriptive and inferential statistical analyses performed on the measurements obtained from the samples in each group. As the novel model of translational healthcare, which integrates translational research and translational effectiveness, becomes increasingly established in modern contemporary medicine, healthcare continues to evolve into a model of care that is evidence-based, effectiveness-focused and patient-centered. Patient-centered care and patient-targeted therapies require the timely and critical development and validation of a new research paradigm, individual patient research (IPR), as opposed to the customary group research approach. Here, we propose a model of individual patient research to define and characterize the effectiveness of a novel therapeutic intervention for temporomandibular joint disorder. The intervention must be tailor-made for each individual patient, and the data from each patient must be analyzed individually. We propose that this endeavor is best achieved by means of an adaptive cluster randomized stepped wedge blinded controlled trial, because it permit individual patient outcomes research and analysis, ensures equipoise, and maintains adequate power. The patient targeted therapies section of the Journal of Translational Medicine must endeavor to facilitate the dissemination of studies that focus broadly on translational research for the ultimate benefit of individual patients.

Lubricin: A Principal Modulator of the Psychoneuroendocrine - Osteoimmune Interactome – Implications for Novel Treatments of Osteoarthritic Pathologies

“…Taken together with observations reported in a systematic review of increased levels of pro-inflammatory cytokines in the synovial fluid of osteoarthritic joints [ 11 ], as well as our own data [ 5 , 6 ], we propose the hypothesis that lubricin is a key modulator of the psychoneuroendocrine-osteoimmune interactome. Our corollary hypothesis states that the regulation of synovial lubricin levels by TH17 cytokines has clinically relevant implications for novel treatments of osteoarthritic pathologies, such as CRISPR/Cas9- mediated genomic modification.…”

“…The best evidence base to date, derived from the studies by Szychlinska and collaborators [ 10 ], de Silva and collaborators [ 11 ], and others, including data from our laboratory [ 5 , 6 ], suggests that pro-inflammatory cytokines produced by myeloid populations, including interleukin (IL)-1b, IL-6 and tumor necrosis factor (TNF)-a will be found to play an important role in this context. Expectations are also that cytokines of the TH17 and TH9 profile may also play an important role in the regulatory modulation of lubricin expression.…”

“…One important interactomic set of relationships is that which coordinates the intertwined cross-regulatory feedback between the psycho-neuroendocrine and immune systems, which we previously discussed in the context of patients with HIV/AIDS afflicted with the immune reconstitution inflammatory syndrome (IRIS) [ 2 ] or with Alzheimer's disease [ 3 ]. Taken together, these lines of investigations have led us to propose a new field of interactomic research, which we labeled psychoneuroendocrineosteoimmunology [ 4 ], that directly pertains to the field of osteoarthritic pathologies [ 5 , 6 ].…”

Evaluation of Temporomandibular Joint in Patients with Parkinson’s Disease: A Comparative Study

“…Bruxism has been observed to alter activity in subcortical, cortical, and spinal circuits, as well as modify deep tendon reflexes in the extremities [40,41]. Previous studies have revealed that muscular tone in various regions of the body can be influenced by mechanosensory signals originating from the jaws, transmitted through the trigeminal nerve [40,42]. Therefore, clenching, bruxism, asymmetry of the TMJs, and morphological differences in the TMJs may be considered as potential risk factors associated with future PD.…”